Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)

Forms and Documents

Document Name	Status
CMS-10524_Supporting_Statement_Part_A.docx Supporting Statement A	2015-12-30

IC Document Collections

IC ID	Document Title	Status
212039	Submitting a Prior Authorization Request and Mailing Medical Records	Modified

ICR Details

OMB Control No: 0938-1293	ICR Reference No: 201512-0938-014
Status: Historical Active	Previous ICR Reference No: 201509-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/24/2016
	Date Received in OIRA: 12/30/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved
Responses	157,500	0	0
Time Burden (Hours)	78,750	0	0
Cost Burden (Dollars)	1,537,500	0	0

---

Abstract: A revision is being made to §414.234 to require, as a condition for payment, submission of a prior authorization request to receive a provisional prior authorization decision for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). A claim with a provisional affirmative prior authorization submitted for processing will be paid as long as all other requirements are met. A claim with a non-affirmative decision or without a decision and submitted for processing will be denied.

---

Authorizing Statute(s): US Code: 42 USC 1395m Name of Law: Social Security Act
  

Citations for New Statutory Requirements: US Code: 42 USC 1395m Name of Law: Social Security Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR85	Final or interim final rulemaking	80 FR 81674	12/30/2015

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Submitting a Prior Authorization Request and Mailing Medical Records

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	157,500	0	0	157,500	0	0
Annual Time Burden (Hours)	78,750	0	0	78,750	0	0
Annual Cost Burden (Dollars)	1,537,500	0	0	1,537,500	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

---

Annual Cost to Federal Government: $7,875,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/30/2015

---